How Do You Get There from Here?

It’s a rainy summer afternoon, and about a dozen of the regulars at the Rappahannock Senior Center in Scrabble are gathered around a table for an after-lunch conversation.

The subject is health care, but not the details of contentious legislation, nor comparisons of personal aches and pains and bodies gone wrong. No, they are talking about the logistics of health care, of getting to appointments, of picking up prescriptions, of jammed doctors’ schedules.

Would you like to join a conversation about addressing healthcare transportation needs in rural Virginia? Join VRHA at our fall event. Chris Blankenship from the New River Agency on Aging will lead the discussion.

Members in the News

It's that time of year again. [VRHA member] Augusta Health is hosting its exploration camp, which gives students hands-on training and an inside look at a career in the medical field.

From July 24-28, middle school students from all across the valley learned to take care of Bob, a fake hospital patient in need of care. Camp lessons include carefully transporting someone on a stretcher, CPR, radiology and more.

More Members in the News

From Bath Community Hospital

After more than four years of dedicated effort, the Bring it Home capital campaign, an unprecedented fundraising effort to offset the cost of the [VRHA member] Bath Community Hospital, has come to a successful end. The campaign committee announced this week that it has officially raised over $4.25 million dollars, exceeding its ambitious $4.2 million dollar goal.

The Bring it Home campaign, chaired by Mr. George Phillips and Mr. Henley Carter, was organized in 2012 after the Bath Community Hospital board of directors recognized the hospital would require substantial renovations to its existing facility in order to address the increasing demands of its patient population. The board committed to a $16 million renovation, if it could be done without the hospital incurring any debt. The proposed renovation would allow for critical improvements to patient care including a new, state-of-the-art emergency department, an onsite helipad, and expanded primary and specialty care service areas.

NOTE: Mr. Phillips and Mr. Carter were the receipients of the 2014 VRHA "Charles Crowder, Jr. Award" for their work to support the hospital. Nominations for the 2017 awards are due September 2nd. Download the nomination form.

Medicaid Expansion Proposal

From the Office of the Governor

Following the United States Senate vote on July 28, it is now clear that the Affordable Care Act will remain the law of the land. As you know, I have been an avid proponent of Medicaid Expansion for the past four years. The benefits are clear: 400,000 more Virginians served, an infusion of federal funds into our state budget, and 30,000 jobs created. So far, we have forfeited over $10 billion by not expanding Medicaid – Virginians’ taxpayer dollars that have gone to Washington and not come back.

Today and for the foreseeable future, the option for Medicaid Expansion exists. I, like you, am hopeful that as members of Congress look for common ground to reform and strengthen the ACA, they can find ways to better serve our most vulnerable citizens. When Congress proposed the imposition of a per capita cap and block grants for Medicaid, we learned that our failure to expand Medicaid put us at a disadvantage.

I would like the opportunity to work with you on a proposal that will be palatable both politically and practically for you and your colleagues. Just as we have done with other major issues facing our Commonwealth like balancing the budget, transportation, and education, I believe we can work together on this urgent matter.

Opioid Prescribing

By Christine Vestal - Stateline

Using 2015 data from retail pharmacy receipts, the CDC for the first time reported the volume and potency of pain tablets sold in the nation’s drugstores and calculated per capita rates of morphine equivalent doses sold at the county level.

Martinsville drugstores came out on top, selling enough Vicodin, Percocet, OxyContin and other opioid painkillers to medicate every man, woman and child in the city for 136 days, nearly seven times the national average.

Martinsville’s health and law enforcement officials are convinced the CDC’s calculation of their city’s opioid consumption is inflated, mainly because people from nearby towns purchase pain medicine in Martinsville, which remains a major market hub for the largely rural region.

No Care to Lose

From the Southern Poverty Law Center

The Senate took a series of votes aimed at repealing parts or all of the Affordable Care Act. Under any of the plans put forth by Republicans – all voted down thus far – millions of Americans would lose their health care coverage, according to the Congressional Budget Office.

But in places like southwestern Virginia, many simply have no health insurance — or access to medical care — to lose.

More than 2,000 people in Wise, Virginia, waited in long lines and sweltering heat for basic health services from the Remote Area Medical Expedition. At a county fairground over a period of three days, volunteer doctors pulled teeth, performed chest X-rays, tested insulin levels, and handed out eyeglasses to people too poor or too sick to get health care any other way.

Four years into the rollout of the Affordable Care Act's major provisions, 29 million Americans still lack health insurance. Millions live in states like Virginia that did not expand Medicaid to childless adults among the working poor, as the law allowed. Even for people helped by government programs like basic Medicaid, veterans' care and disability, there are many gaps: Low-income people struggle to afford co-payments, the gas to drive to a doctor and prescription drugs.

Close to Home

People who live in rural Appalachia are being left behind, with an infant-mortality rate and life expectancy that lags the gains made in the rest of the country, according to a new study.

The 13-state region, that traces the spine of the Appalachian Mountains from New York to Mississippi, has long faced economic challenges, with a dependence on struggling industries such as mining and forestry. But the analysis found that the health gaps are relatively new and have widened. As the rest of the country has made health gains, Appalachia has failed to keep up.

The health crisis in rural America that has received the most attention in recent years is the epidemic of opioid abuse, a contributor to a rise in the mortality rate for middle-aged white people. But drug overdoses accounted for a relatively small amount of the life expectancy gap between health in rural Appalachia and the rest of the country, at least through the end of the study in 2013.

Action Alert!

Congress has long recognized the importance of the rural health care safety net and has steadfastly worked to protect it. And now, much of the protections created to maintain access to care for the 62 million who live in rural America are in jeopardy.

The Virginia Rural Health Association is asking Congress to continue its fight to protect rural patients’ access to care. At minimum, three provisions are critical for rural patients and providers:

Medicaid Reform

Market Reform

Stop Bad Debt Cuts to Rural Hospitals

VRHA, in partnership with the National Rural Health Association, is asking its members to contract your members of Congress. Ask them to protect the rural health care safety net through these three provisions.

Contact information for Virginia's Congressional members is here. Not sure which Representative serves your area? Look it up here. You can also read a sample of the letters VRHA submitted.

New Model for Rural Care

By John Commins - Health Leaders Media

The ongoing and well-publicized struggles of small, isolated hospitals to keep the lights on and the doors open has prompted calls for significant reforms for care delivery in rural America. The latest proposal comes from a group of emergency physicians in Michigan, who have called for better coordination of care between emergency and primary care clinicians.

"Our emergency medicine-primary care model embraces the role that emergency departments play in providing primary care in rural areas while also connecting patients to other physicians and resources in the community,” ," said Margaret Greenwood-Ericksen, MD, MPH. “Rural hospitals can serve as a hub for emergency care, primary and preventive care, and social services for improving rural population health."

SNAP and Rural Groceries

By Bryce Oates and Tim Marema - Daily Yonder

As a new report shows that rural households are about 25% more likely than urban ones to participate in the Supplemental Nutrition Assistance Program (SNAP), rural grocers say the federal nutrition program is an important part of the revenue that keeps their stores in business.

“The way I see it, SNAP is one of the best government programs out there,” said Kip Yoss, who owns and operates two independent grocery stores in rural West Missouri. “It really helps us pay our utilities, our workers, and keep the doors open.”

Yoss said his stores earn about 11% of sales from SNAP, which provides a cash-like benefit to low-income Americans that can be spent only on food items. Other stores Yoss works with in harder-hit rural areas earn as much as 20-30% of their revenue from SNAP, he said. SNAP accounts for 9% of grocery sales nationally, according to the Food Marketing Institute.

Model Program: Alabama Public Health Telehealth Network
The Alabama Department of Public Health has created telehealth communications to increase efficiency among ADPH statewide programs and to partner with external healthcare partners to use county health departments as telehealth originating sites.

Model Program: Regional Initiatives in Dental Education (RIDE)
To meet the unique oral health needs of patients in rural and underserved areas, a special training program, RIDE, was created by the University of Washington's School of Dentistry.

Widening Health Disparities in Appalachia
New research examining health outcomes in the Appalachian region finds a widening gap for health disparities and a stronger association between poverty and life expectancy than in other parts of the country. Higher mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease, diabetes, suicide, unintentional injury and drug overdose were among the conditions having a greater impact in the region and contributing to higher mortality. The HRSA-affiliated co-authors of the report compared disparities between Appalachia and the rest of the United States in the period of 1990-2013 and found a dramatic increase in that timeframe.

Navigating Value-Based Payment Initiatives
The Rural Health Value team has just released two resources that summarize select innovative demonstrations and programs for rural health care. The first is an updated Catalog of Value-Based Initiatives for Rural Providers, designed to help communities identify value-based programs most appropriate for rural participation. The second resource focuses on the State Innovation Model (SIM) Testing Awards, summarizing early accomplishments of rural-related activities in the first six states – Arkansas, Colorado, Idaho, Minnesota, Oregon, and Vermont – to receive these awards. Rural Health Value is supported by a cooperative agreement between FORHP, the RUPRI Center for Rural Health Policy Analysis, and Stratis Health to help rural providers understand and engage with the rapidly evolving health care payment and delivery system through analysis and technical assistance.

Individual and Family Support Program Funding
The Virginia Department of Behavioral Health and Developmental Services (DBHDS) is pleased to announce the opening of the FY 2018 Individual and Family Support Program (IFSP) on August 17, 2018. To be eligible for this program an individual must:
1) be on the DD Waiver Waitlist; and
2) have provided receipts from any previous IFSP funding period (only if you have received funds in the past).
New this year, all applications must be completed using the on-line application system.
Deadline: November 17

Henry Schein Cares Medal
The Henry Schein Cares Medal recognizes excellence in expanding access to healthcare for the underserved nationwide. Applying nonprofit organizations must demonstrate that their submitted program has expanded access to healthcare for the underserved in a novel and innovative way that is measurable and quantifiable. Emphasis will be placed on access to healthcare for children (birth to age 18), although all efforts to expand access to care will be considered, including those involving companion animal health. Programs must demonstrate potential for replication and large-scale impact. Three finalists will be selected among applicants from each of three fields: oral health, animal health, and medicine. In each category, a gold, silver, and bronze medalist will be chosen. Each medalist will receive a cash award in the following amounts: $15,000 for gold, $10,000 for silver, and $5,000 for bronze. In addition to the cash awards, each finalist will receive $10,000 worth of product from Henry Schein, Inc.
The application deadline is October 5, 2017.

Southwest Airlines Medical Transportation Grant Program
The Southwest Airlines Medical Transportation Grant Program provides complimentary, roundtrip tickets to nonprofit hospitals in communities served by the airline as well as to nonprofit medical transportation organizations. The tickets are then distributed by the organizations to deserving patients and their caregivers who must travel for medical care. Organizations interested in applying must be either a nonprofit hospital offering specialized care in a city that is served by Southwest Airlines, or a nonprofit medical transportation organization whose primary mission is to assist patients with their transportation needs.
The application deadline is September 30, 2017.

Culture of Health Prize
Awards that honor collaborative, community-based efforts that are prioritizing health and empowering people in the community to live healthier lives.
Geographic coverage: Nationwide
Letter of Intent (Required): Nov 3, 2017
Application Deadline: Jan 18, 2018

Rural Promise NeighborhoodsThe Department of Education (ED) funds Promise Neighborhoods to improve the educational and developmental outcomes of youth in distressed communities by strengthening schools and systems of family and community support. Applicants must apply under one of three priority areas, including proposals to serve rural communities or American Indian tribes. Research has documented a strong link between poorer educational achievement and worse health outcomes. This is important for rural areas where students in fourth grade perform well compared to their urban counterparts but continue to lag behind in behavioral health outcomes and longer-term educational attainment. Eligible applicants include nonprofit organizations and institutions of higher education partnering with local schools districts and elementary or secondary schools.
The ED strongly encourages interested applicants to submit a notice of intent by August 21.
Deadline: September 5